23D2057948 CLIA NUMBER - MCLAREN CENTRAL MICHIGAN - TAMARA MOUTSATSON, DO, FACOI

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Laboratory Demographics

CLIA Number: 23D2057948

Facility Name: MCLAREN CENTRAL MICHIGAN - TAMARA MOUTSATSON, DO, FACOI

Facility Address:
2853 HEALTH PARKWAY SUITE A
MOUNT PLEASANT, MI
ZIP 48858
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Facility Phone Number: 989 779-5222

Facility Type: Rural Health Clinic

Certificate Type: Waiver

NPI Number: 1487274940

Taxonomy: 261QR1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	23D2057948
LAB Type	Rural Health Clinic
Facility Name	MCLAREN CENTRAL MICHIGAN - TAMARA MOUTSATSON, DO, FACOI
Street	2853 HEALTH PARKWAY SUITE A
City	MOUNT PLEASANT
State	MI
ZIP	48858
Phone	989 779-5222
CertificateType	4
CertificateEffectiveDate	4/26/2023
CertificateExpirationDate	4/25/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024